Pediatric emergency medicine trisk 4521 4521
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FIGURE 131.27 Hyperechoic spinous processes.
In most cases, the static technique is used to identify anatomical landmarks
before the procedure. It is feasible to use ultrasound in real time; however, there
are challenges to the dynamic technique. First, the procedure requires a sterile
sheath and sterile gel. Second, it may require a second person to hold the probe
while the clinician performing the lumbar puncture inserts the needle. In the
dynamic technique, the probe is placed in the longitudinal axis and the needle
inserted below the probe (Fig. 131.30 ). This technique may be cumbersome for
the novice sonographer.
Pitfalls
The major pitfall with imaging the spine is being off axis. Like the spinous
process, the transverse process will also appear hyperechoic and may confuse the
sonographer. To avoid confusion, clinicians should scan side to side, and up and
down, and ensure that the bony landmarks identified as the spinous processes are
the most superficial. Then the transverse view of the spine can confirm the image
is midline and not off axis.
